staceykeatingfitness@gmail.com
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A. If you are a new client firstly, please fill out our health questionnaire below. If you are an existing client, please proceed straight section B. below:
Name
*
First
Last
Let me know your MAIN reasons for joining? Can select more than 1
Weight loss / fat loss
Improve Fitness
Gain self esteem / improve self esteem
Support emotional health (anxiety, depression)
Gain more energy
Tone up / get stronger
General wellbeing / fitness
Have fun & meet new people
Do you have any previous, or existing injuries, joint complaints, or medical conditions including anxiety, depression (this information allows us to support you best!)
Please mention below:
Share with us more of your goals, concerns, questions and how we can help you:
Membership Terms & Conditions
All memberships are an ongoing recurring weekly (direct debit) or upfront term payment. Memberships are a 10 week/ term commitment and can only be changed / cancelled after the 10 week term is complete.
Signature & Date Please:
Comments
This field is for validation purposes and should be left unchanged.
B. Secondly, lets set up your payment details:
Fitness Classes – 24 session pass – 2 a week (direct debit)
$
26.00
/ week for 12 weeks
Fitness Classes – 24 session pass (direct debit)
Out of stock